May
2007
Parkinson’s Disease
Parkinson’s Disease
Parkinson’s Disease is a progressive degenerative disease that destroys a part of the brain, in particular the midbrain’s basal ganglia, and it helps to control movement. Millions of people have it now. Rare before the age of 40, 1% over the age of 65, and 2.5% of people over the age of 80. Parkinson’s Disease that causes dementia affects about 0.2- 0.5% of people over the age of 65. Parkinson’s Disease peaks between 70-79 years of age and is twice a common in men compared to women.
Cause of Parkinson’s Disease: we aren’t sure. It might be genetic. Perhaps exposures are associated with Parkinson’s Disease, such as pesticides and heavy metals (mercury, zinc, iron, manganese). The basal ganglia release dopamine, a chemical to help control movement in the body. In Parkinson’s Disease, there is a lack of dopamine release from the basal ganglia to the key movement center of the brain.
Symptoms: Falling down, change in walking, worsening of handwriting, slowing down in movement, resting tremor that goes away with movement. Fatigue, dementia, even psychosis. Drop in blood pressure, incontinence, erective dysfunction, slow GI system can occur with worsening Parkinson’s Disease
Signs: 1) A resting tremor. Pill rolling tremor is seen so the thumb and index finger look like they are rolling a small marble. 2) Rigidity. On exam, while extending the arm it looks like a cogwheel movement – an unsmooth mechanical motion. 3) Akinesia, meaning lack of movement. Even the face is blank, called a masked face. 4) Gait disturbance, so turning around can call a fall. Shuffling the feet occurs.
Other diseases that can be mistaken as Parkinson’s Disease include a stroke to the basal ganglia, progressive supranuclear palsy, and multiple system atropy. Some medicines cause Parkinson-like symptoms. These drugs block dopamine receptors of the brain. Antipsychotics are big ones doing this. Metoclopramide (Reglan) for GI motility can cause this.
Treatment: no cure unfortunately. Medications don’t slow down this progressive disease. But researchers are working on drugs to slow it down.
For symptom treatment, levodopa (such as Sinemet) is used to replete the lack of dopamine in the brain. MAO B inhibitor, such as selegiline, is used – and you hear all the pharmaceutical commercials say, “Don’t use our drug if you take an MAOi.” Dopamine receptor agonists include Mirapex, Requip, Parlodel, and Permax. Also anticholinergics can be helpful in Parkinson’s Disease, such as amantadine and Cogentin. COMT inhibitors (Tasmar, Comtan) are used to assist levodopa drugs, because levodopa tends to “wear off” between dosings and after 5 years usually aren’t as effective as once before. In postmenopausal women, estrogen might be helpful – but then there is increased risk of heart attack, blood clot, and breast cancer.
Unfortunately all these medicines have side effects, like fatigue, nausea, headaches.
Surgical procedures are still being investigated.
It is vital to see a neurologist and discuss all your options with him/her.
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drjohnhong 
neurological, senior citizen 
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